Rifaximin for the Secondary Prevention of Recurrent Pouchitis

Inclusion Criteria: * Informed consent will be obtained before any study-related procedures * Age \> 18 and \<75 years * Participants with a proven history of ulcerative colitis and history of 1,2, modified -2 or 3 stage Ileal pouch anal anastomosis (IPAA) and ileostomy takedown * Diagnosis of initial episode of pouchitis within the first 12 months after ileostomy takedown/final stage of IPAA surgery Exclusion Criteria: * Known hypersensitivity to rifaximin or its metabolites * Known Crohn's disease * History of perianal fistula * Known incontinence due to anal sphincter dysfunction * Known irritable pouch syndrome * Active ongoing pelvic infection/sepsis at baseline visit * New onset of high bowel frequency in the setting of acute pouchitis in the first 4 weeks after IPAA * Known Clostridoides difficile infection * Need for antibiotic long-term therapy (e.g. doxycycline for acne) * Known active Hepatitis B, C, HIV * Clinically significant liver disease (Primary Sclerosing Cholangitis with LFT's \<1.5 upper limit of normal can be included) * Severe hepatic impairment, defined as Child-Pugh Class C * Concomitant use of p-glycoprotein (P-gp) inhibitors (e.g. cyclosporine) * Known decreased kidney function with a glomerular filtration rate \<60 ml/min/1.732 * Fecal microbiota transplantation within 16 weeks before ileostomy takedown * History of malignancy, except for basal cell carcinoma, non-metastatic squamous cell carcinoma of the skin, or prior malignancy with curative t…